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Mmm this form is badly coded a few things i notice off the bat include

1)The use of $_REQUEST instead of just using the $_POST array
2)Using javascript to validate the form, way bad idea you should be using php to validate a php form
3)Using a user submitted email in this part $headers = 'From: ' . $email . "\r\n" . this can lead to some pretty bad header injections never allow the user to submit any form data inside headers if you do require it besure you are cleaning the data properly in order to prevent header injections

lastly its good practice to throw in a exit; after your header redirect this means if for some reason the page does not redirect properly the rest of the script is ended.

like i said these are just a few things if you would like me to rebuild the form for you i can but will charge a tad for my time its up to you. Hope ive helped some.

Mmm this form is badly coded a few things i notice off the bat include

1)The use of $_REQUEST instead of just using the $_POST array
2)Using javascript to validate the form, way bad idea you should be using php to validate a php form
3)Using a user submitted email in this part $headers = 'From: ' . $email . "\r\n" . this can lead to some pretty bad header injections never allow the user to submit any form data inside headers if you do require it besure you are cleaning the data properly in order to prevent header injections

lastly its good practice to throw in a exit; after your header redirect this means if for some reason the page does not redirect properly the rest of the script is ended.

like i said these are just a few things if you would like me to rebuild the form for you i can but will charge a tad for my time its up to you. Hope ive helped some.